What is the recommended treatment for gum infection intervention?

Treatment for Gum Infection

The recommended first-line treatment for gum infection (gingivitis) is thorough mechanical plaque removal through proper brushing and flossing, combined with professional dental cleaning, while antibiotics should be reserved only for severe cases with systemic involvement or in immunocompromised patients. 1, 2

Diagnosis and Classification

Gum infections typically present as:

• Gingivitis: Reversible inflammation limited to the gums
• Periodontitis: Advanced disease with destruction of supporting tissues

Signs and symptoms include:

• Redness, swelling, and bleeding of gums
• Pain or tenderness
• Bad breath
• Receding gums
• Loose teeth (in advanced cases)

Treatment Algorithm

Step 1: Non-Pharmacological Interventions (First-Line)

• Mechanical plaque removal:

  • Brushing teeth twice daily with fluoride toothpaste using the Bass or modified Bass method 1
  • Use a soft toothbrush to reduce risk of bleeding 1
  • Clean between teeth once daily with appropriate interdental cleaners 1
  • Professional dental cleaning to remove plaque and calculus

• Oral hygiene instructions:

  • Rinse with alcohol-free mouthwash at least four times daily 1
  • Maintain proper denture care if applicable 1
  • Avoid painful stimuli (smoking, alcohol, spicy foods, hot drinks) 1

Step 2: Antimicrobial Therapy (For Persistent or Severe Cases)

• Local antimicrobial agents:

  • Chlorhexidine 0.2% mouthwash for 7-14 days
  • Hydrogen peroxide rinses

• Systemic antibiotics (Reserved for severe cases with systemic involvement or in immunocompromised patients):

  • Amoxicillin 500 mg three times daily for 7 days 3, 4
  • For penicillin-allergic patients: Clindamycin 600 mg or Azithromycin 500 mg 2
  • For advanced periodontitis with multiple abscesses: Combined therapy of amoxicillin with metronidazole 4

Special Considerations

Prophylaxis Requirements

• Antibiotic prophylaxis is necessary for dental procedures involving manipulation of gingival tissue in high-risk patients, including those with:
  • Prosthetic cardiac valves
  • Previous history of infective endocarditis
  • Certain congenital heart defects
  • Cardiac transplant recipients with valvulopathy
  • Severe immunocompromise 2

Environmental Infection Control

• After each patient treatment, clean and disinfect dental unit surfaces with an EPA-registered "hospital disinfectant" labeled for "tuberculocidal" activity 1
• A 1:100 dilution of household bleach (sodium hypochlorite) is an effective and inexpensive disinfectant 1

Monitoring and Follow-up

• Evaluate response to treatment within 1-2 weeks
• For patients with periodontitis, regular maintenance visits every 3-4 months are essential to prevent recurrence
• Patients with a history of periodontitis remain at increased risk for recurrent disease and require close monitoring 5

Common Pitfalls to Avoid

1. Overuse of antibiotics: Unnecessary antibiotic use contributes to resistance and can cause adverse effects including allergic reactions, diarrhea, and C. difficile infections 2
2. Inadequate mechanical plaque removal: Relying solely on antimicrobial agents without addressing the underlying cause
3. Failure to identify systemic conditions: Some gingival diseases may be manifestations of systemic conditions requiring additional treatment 5
4. Delayed treatment: Untreated gingivitis can progress to periodontitis with irreversible damage to supporting structures

Remember that maintaining optimal oral hygiene is more important than antibiotic prophylaxis for preventing complications 2. Early intervention with proper mechanical plaque removal can completely reverse gingivitis before it progresses to periodontitis with permanent tissue damage 6, 5.